New study aims to understand opioid fill patterns in children

A new study describes trends in filled opioid prescriptions by patient and clinical characteristics for Medicaid-enrolled children. Findings from the study will be presented during the Pediatric Academic Societies (PAS) 2019 Meeting, taking place on April 24—May 1 in Baltimore.

"In this retrospective cohort study of Medicaid-enrolled children and young adults (1 to 21 years old) we found that filled opioid prescriptions are relatively rare (1% of all visits) and adjusted rates decreased from 2012 to 2016," said Abbey Masonbrink, MD, MPH, a pediatric hospitalist at Children's Mercy Kansas City and one of the authors of the study. "Providers frequently prescribed opioids combined with non-opioid analgesics and opioids with a black box or safety warning. Future efforts should support development of pediatric pain management guidelines based in a multimodal approach to minimize use of opioids and target reduction of opioids with pediatric safety warnings."

This study involved a retrospective cohort study of children 1 to 21 years old enrolled in Medicaid from 2012-2016 using the IBM Watson Medicaid Marketscan claims database. It defined clinical visits as an "opioid visit" if there was a new opioid prescription filled in a retail pharmacy within seven days of the visit. The opioid visit was then assigned to the clinical provider most likely to have prescribed an opioid. Only visits to providers submitting claims in every year from 2012-2016 were included. Changes in patient and clinical characteristics over time were assessed using descriptive statistics and chi-square tests and logistic regression was used to estimate the change in adjusted probability of an opioid visit over time. Due to the large volume of visits analyzed, p<0.001 was considered statistically significant.

From 2012 to 2016, there were 113,068,027 visits among Medicaid-enrolled children and 1% (n=1,130,006) of these were considered an opioid visit. After adjusting for patient demographics, the researchers found that the adjusted probability for an opioid prescription decreased from 1.2% to 0.8% from 2012 to 2016. The clinical settings with the highest adjusted rates of opioid prescriptions were dental surgery (29%), surgery (21%), and inpatient (upon-discharge) (10%). Furthermore, the adjusted rates of an opioid visit significantly decreased (p<0.001) from 2012-2016 in all settings, except dental surgery and surgery. The most frequently prescribed opioids were hydrocodone (48%), codeine (22%), and oxycodone (14%); most of these prescriptions were in combination with acetaminophen or ibuprofen.

Opioid prescriptions filled in Medicaid-enrolled children are relatively rare (1% of all visits), however adjusted rates of opioid visits decreased from 2012 to 2016. Understanding changes in prescriptions over time can inform opioid stewardship efforts to develop clinical guidelines for appropriate pain management in children.